Ethics of Procuring and Using Organs or Tissue from Infants and Newborns for Transplantation, Research, or Commercial Purposes: Protocol for a Bioethics Scoping Review.
Since the inception of transplantation, it has been crucial to ensure that organ or tissue donations are made with valid informed consent to avoid concerns about coercion or exploitation. This issue is particularly challenging when it comes to infants and younger children, insofar as they are unable to provide consent. Despite their vulnerability, infants' organs and tissues are considered valuable for biomedical purposes due to their size and unique properties. This raises questions about the conditions under which it is permissible to remove and use these body parts for transplantation, research, or commercial purposes. The aim of this protocol is to establish a foundation for a scoping review that will identify, clarify, and categorise the main ethical arguments regarding the permissibility of removing and using organs or tissues from infants. The scoping review will follow the methodology outlined by the Joanna Briggs Institute (JBI), consisting of five stages: (1) identifying the research question, (2) developing the search strategy, (3) setting inclusion criteria, (4) extracting data, and (5) presenting and analysing the results. We will include both published and unpublished materials that explicitly discuss the ethical arguments related to the procurement and use of infant organs or tissues in the biomedical context. The search will cover various databases, including the National Library of Medicine, Web of Science, EBSCO, and others, as well as grey literature sources. Two raters will independently assess the eligibility of articles, and data from eligible studies will be extracted using a standardised form. The extracted data will then be analysed descriptively through qualitative content analysis.
There has been debate about how to respect the rights and interests of organ and tissue donors since the beginning of transplantation practice, given the moral risks involved in procuring parts of their bodies and using them for transplantation or research. A major concern has been to ensure that, at a minimum, donation of organs or other bodily tissues for transplantation or research is done under conditions of valid informed consent, so as to avoid coercion or exploitation among other moral harms. In the case of infants and younger children, however, this concern poses special difficulties insofar as infants and younger children are deemed incapable of providing valid consent. Due to their diminutive size and other distinctive properties, infants' organs and tissues are seen as valuable for biomedical purposes. Yet, the heightened vulnerability of infants raises questions about when and whether it is ever permissible to remove these body parts or use them in research or for other purposes. The aim of this protocol is to form the basis of a systematic scoping review to identify, clarify, and systematise the main ethical arguments for and against the permissibility of removing and using infant or newborn (hereafter, "infant") organs or tissues in the biomedical context (i.e. for transplantation, research, or commercial purposes).
Our scoping review will broadly follow the well-established methodology outlined by the Joanna Briggs Institute ( Peters et al., 2020). We will follow a five-stage review process: (1) identification of the research question, (2) development of the search strategy, (3) inclusion criteria, (4) data extraction, and (5) presentation and analysis of the results. Published and unpublished bibliographic material (including reports, dissertations, book chapters, etc.) will be considered based on the following inclusion criteria: the presence of explicit (bio)ethical arguments or reasons (concept) for or against the procurement and use of organs or tissues from infants, defined as a child from birth until 1 year old (population), in the biomedical domain, including transplantation, research, and commercial development (context). We will search for relevant studies in the National Library of Medicine (including PubMed and MEDLINE), Virtual Health Library, Web of Science, Google Scholar, EBSCO, Google Scholar, PhilPapers, The Bioethics Literature Database (BELIT), EthxWeb as well as grey literature sources (e.g., Google, BASE, OpenGrey, and WorldCat) and the reference lists of key studies to identify studies suitable for inclusion. A three-stage search strategy will be used to determine the eligibility of articles, as recommended by the JBI methodological guidelines. We will exclude sources if (a) the full text is not accessible, (b) the main text is in a language other than English, or (c) the focus is exclusively on scientific, legal, or religious/theological arguments. All articles will be independently assessed for eligibility between two raters (MB & XL); data from eligible articles will be extracted and charted using a standardised data extraction form. The extracted data will be analysed descriptively using basic qualitative content analysis.
Ethical review is not required as scoping reviews are a form of secondary data analysis that synthesise data from publicly available sources. Our dissemination strategy includes peer review publication, presentation at conferences, and outreach to relevant stakeholders.
The results will be reported according to the PRISMA-ScR guidelines. An overview of the general data from the included studies will be presented in the form of graphs or tables showing the distribution of studies by year or period of publication, country of origin, and key ethical arguments. These results will be accompanied by a narrative summary describing how each included study or article relates to the aims of this review. Research gaps will be identified and limitations of the review will also be highlighted.
A paper summarising the findings from this review will be published in a peer-reviewed journal. In addition, a synthesis of the key findings will be disseminated to biomedical settings (e.g., conferences or workshops, potentially including ones linked to university hospitals) in the UK, USA, Türkiye, and Singapore. They will also be shared with the academic community and policy makers involved in the organ procurement organisations (OPO), which will potentially consider our recommendations in their decision-making processes regarding infant tissue/organ donation practice in these countries.
The use of a rigorous, well-established methodological framework will ensure the production of a high-quality scoping review that will contribute to the bioethics literature.A comprehensive search of disciplinary and cross-disciplinary databases will be undertaken to ensure coverage of all possible sources that meet the inclusion criteria for the review.This review will focus exclusively on infant tissue/organ procurement/use in biomedical contexts, providing a comprehensive and reliable source of ethical arguments for future debates on this sensitive topic.The review will be limited to articles published in English, which increases the risk of missing relevant sources published in other languages.The review will be limited to articles for which the full text is available, which increases the risk of missing relevant sources that otherwise may have been included in the scoping review had the full text been accessible.
Barış M
，Lim X
，T Almonte M
，Shaw D
，Brierley J
，Porsdam Mann S
，Nguyen T
，Menikoff J
，Wilkinson D
，Savulescu J
，Earp BD
... -
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Exposure to hate in online and traditional media: A systematic review and meta-analysis of the impact of this exposure on individuals and communities.
People use social media platforms to chat, search, and share information, express their opinions, and connect with others. But these platforms also facilitate the posting of divisive, harmful, and hateful messages, targeting groups and individuals, based on their race, religion, gender, sexual orientation, or political views. Hate content is not only a problem on the Internet, but also on traditional media, especially in places where the Internet is not widely available or in rural areas. Despite growing awareness of the harms that exposure to hate can cause, especially to victims, there is no clear consensus in the literature on what specific impacts this exposure, as bystanders, produces on individuals, groups, and the population at large. Most of the existing research has focused on analyzing the content and the extent of the problem. More research in this area is needed to develop better intervention programs that are adapted to the current reality of hate.
The objective of this review is to synthesize the empirical evidence on how media exposure to hate affects or is associated with various outcomes for individuals and groups.
Searches covered the period up to December 2021 to assess the impact of exposure to hate. The searches were performed using search terms across 20 databases, 51 related websites, the Google search engine, as well as other systematic reviews and related papers.
This review included any correlational, experimental, and quasi-experimental study that establishes an impact relationship and/or association between exposure to hate in online and traditional media and the resulting consequences on individuals or groups.
Fifty-five studies analyzing 101 effect sizes, classified into 43 different outcomes, were identified after the screening process. Initially, effect sizes were calculated based on the type of design and the statistics used in the studies, and then transformed into standardized mean differences. Each outcome was classified following an exhaustive review of the operational constructs present in the studies. These outcomes were grouped into five major dimensions: attitudinal changes, intergroup dynamics, interpersonal behaviors, political beliefs, and psychological effects. When two or more outcomes from the studies addressed the same construct, they were synthesized together. A separate meta-analysis was conducted for each identified outcome from different samples. Additionally, experimental and quasi-experimental studies were synthesized separately from correlational studies. Twenty-four meta-analyses were performed using a random effects model, and meta-regressions and moderator analyses were conducted to explore factors influencing effect size estimates.
The 55 studies included in this systematic review were published between 1996 and 2021, with most of them published since 2015. They include 25 correlational studies, and 22 randomized and 8 non-randomized experimental studies. Most of these studies provide data extracted from individuals (e.g., self-report); however, this review includes 6 studies that are based on quantitative analysis of comments or posts, or their relationship to specific geographic areas. Correlational studies encompass sample sizes ranging from 101 to 6829 participants, while experimental and quasi-experimental studies involve participant numbers between 69 and 1112. In most cases, the exposure to hate content occurred online or within social media contexts (37 studies), while only 8 studies reported such exposure in traditional media platforms. In the remaining studies, the exposure to hate content was delivered through political propaganda, primarily associated with extreme right-wing groups. No studies were removed from the systematic review due to quality assessment. In the experimental studies, participants demonstrated high adherence to the experimental conditions and thus contributed significantly to most of the results. The correlational and quasi-experimental studies used consistent, valid, and reliable instruments to measure exposure and outcomes derived from well-defined variables. As with the experimental studies, the results from the correlation and quasi-experimental studies were complete. Meta-analyses related to four dimensions were performed: Attitudinal changes, Intergroup dynamics, Interpersonal behaviors, and Psychological effects. We were unable to conduct a meta-analysis for the "Political Beliefs" dimension due to an insufficient number of studies. In terms of attitude changes, exposure to hate leads to negative attitudes (d Ex = 0.414; 95% confidence interval [CI] = 0.005, 0.824; p < 0.05; n = 8 and d corr = 0.322; 95% CI = 0.14, 0.504; p < 0.01; n = 2) and negative stereotypes (d Ex = 0.28; 95% CI = -0.018, 0.586; p < 0.10; n = 9) about individuals or groups with protected characteristics, while also hindering the promotion of positive attitudes toward them (d exp = -0.227; 95% CI = -0.466, 0.011; p < 0.10; n = 3). However, it does not increase support for hate content or political violence. Concerning intergroup dynamics, exposure to hate reduces intergroup trust (d exp = -0.308; 95% CI = -0.559, -0.058; p < 0.05; n = 2), especially between targeted groups and the general population, but has no significant impact on the perception of discrimination among minorities. In the context of Interpersonal behaviors, the meta-analyses confirm a strong association between exposure to hate and victimization (d corr = 0.721; 95% CI = 0.472, 0.97; p < 0.01; n = 3) and moderate effects on online hate speech perpetration (d corr = 0.36; 95% CI = -0.028, 0.754; p < 0.10; n = 2) and offline violent behavior (d corr = 0.47; 95%CI = 0.328, 0.612; p < 0.01; n = 2). Exposure to online hate also fuels more hate in online comments (d = 0.51; 95% CI = 0.034-0.984; p < 0.05; n = 2) but does not seem to affect hate crimes directly. However, there is no evidence that exposure to hate fosters resistance behaviors among individuals who are frequently subjected to it (e.g. the intention to counter-argue factually). In terms of psychological consequences, this review demonstrates that exposure to hate content negatively affects individuals' psychological well-being. Experimental studies indicate a large and significant effect size concerning the development of depressive symptoms due to exposure (d exp = 1.105; 95% CI = 0.797, 1.423; p < 0.01; n = 2). Additionally, a small effect size is observed concerning the link between exposure and reduced life satisfaction(d corr = -0.186; 95% CI = -0.279, -0.093; p < 0.01; n = 3), as well as increased social fear regarding the likelihood of a terrorist attack (d corr = -0.206; 95% CI = 0.147, 0.264; p < 0.01 n = 5). Conversely, exposure to hate speech does not seem to generate or be linked to the development of negative emotions related to its content.
This systematic review confirms that exposure to hate in online and in traditional media has a significant negative impact on individuals and groups. It emphasizes the importance of taking these findings into account for policymaking, prevention, and intervention strategies. Hate speech spreads through biased commentary and perceptions, normalizing prejudice and causing harm. This not only leads to violence, victimization, and perpetration of hate speech but also contributes to a broader climate of hostility. Conversely, this research suggests that people exposed to this type of content do not show increased shock or revulsion toward it. This may explain why it is easily disseminated and often perceived as harmless, leading some to oppose its regulation. Focusing efforts solely on content control may then have a limited impact in driving substantial change. More research is needed to explore these variables, as well as the relationship between hate speech and political beliefs and the connection to violent extremism. Indeed, we know very little about how exposure to hate influences political and extremist views.
Madriaza P
，Hassan G
，Brouillette-Alarie S
，Mounchingam AN
，Durocher-Corfa L
，Borokhovski E
，Pickup D
，Paillé S
... -
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ResearchGate
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钛学术
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